Since 2018, Mellisa Pensa, MD, MPH, has been a family physician at Fair Haven Community Health Care (FHCHC). From July 2019 until the summer of 2022, Pensa served as an ambulatory site director for the Yale Internal Medicine Residency Program, overseeing the outpatient continuity experience for 12 Yale School of Medicine (YSM) Internal Medicine residents. Pensa says teaching is much of what drives her to do medicine. “As physicians, we are constantly teaching. First and foremost, we teach our patients,” and working with residents allows for a more sophisticated level of teaching.
Fair Haven Community Health Care—a federally qualified health center that operates a community health clinic and offers additional services such as behavioral health—is a popular site for residents. Residents have a continuity practice at FHCHC over their three-year Internal Medicine residency training, caring for a panel of 50-150 patients, depending on the year of training. Residents rotate through the clinic, spending two weeks at FHCHC, then six weeks away before returning. The trainees work in teams with residents from other rotation blocks, so that there always is a resident available to care for a patient. More than sixty percent of the patients at FHCHC only speak Spanish.
While the section chief leads didactic learning, much of the learning in a residency is experiential and applied learning. As resident site director, Pensa oversaw the outpatient curriculum for residents, which includes helping residents manage patient panels. “In medicine, very few things are clear cut,” says Pensa. This is particularly true in an outpatient environment versus the hospital setting, where there is a whole team focusing on each patient and easy access to quick laboratory work and tests. Pensa enjoys engaging residents in conversation trying to understand what is going on with their patients, and “really values the residents’ perspective.” She cares deeply about helping residents develop their own styles, to give them confidence to practice medicine and feel positive about decision-making.
Another significant element of the outpatient curriculum is helping residents interpret their population health data, such as about breast cancer screening, high blood pressure, and diabetes. She helps residents try to address health data trends, for example assisting a resident as they develop a project to improve the percentage of patients who get screened for colon cancer.
The outpatient curriculum also focuses on improving the quality of health care. For example, Pensa worked with one resident who wanted to train her co-residents on prescribing medicine for patients with diabetes, helping the resident craft the curriculum.
Pensa praises Mario Ochoa-Prieto, MD, an attending at FHCHC who took over for her as resident site director in July, for developing an advocacy curriculum for residents—focusing, for example, on how to write an op-ed. The need for advocacy in underserved populations is enormous. One resident was incredibly passionate about improving a barrier that exists for uninsured patients needing mammograms. Due to stipulations in grant funding, there is a requirement for patients to have a breast exam before scheduling a mammogram. This creates a barrier—requiring time and transit—that does not exist for insured patients. The advocacy curriculum is aimed at giving residents skills and tools to effectively advocate on issues such as these.
Pensa left her role as site director in July to pursue leadership positions within FHCHC, but she continues to precept the residents. (While she primarily is focused on residents, Pensa informally mentors medical students when they reach out to her.) Pensa finds it rewarding to see the residents’ growth over time. She describes how when a new group arrives in July, she is reminded how much new residents do not know, something she almost forgets because residents are so much more independent by the end of their first year. “The new residents do not know the system or have confidence yet,” Pensa says, adding it is “really fun to watch their growth and development and be part of it as they pick up on the practice of medicine.”
By the time residents are in their third year, Pensa adds, “they are teaching me.” Since residents are also performing rotations in the hospital, they are exposed to a level or depth that she does not readily access in clinic. Many of the residents who rotate with FHCHC go on to specialize, and they bring their knowledge of the latest research in that field to the clinic. Pensa reflects, “that is the goal. You want your mentee to surpass your own skill set. You want to provide them with learning tools that they need to succeed.”